Provider Demographics
NPI:1821495102
Name:ROSELL, ALISSA WOLFE (PT, DPT, OMPT, OCS)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:WOLFE
Last Name:ROSELL
Suffix:
Gender:F
Credentials:PT, DPT, OMPT, OCS
Other - Prefix:DR
Other - First Name:ALISSA
Other - Middle Name:NICOLE
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44-1144 KAMEHAMEHA HWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:KANEOHE
Mailing Address - State:KS
Mailing Address - Zip Code:96744
Mailing Address - Country:US
Mailing Address - Phone:808-247-9408
Mailing Address - Fax:
Practice Address - Street 1:1105 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502
Practice Address - Country:US
Practice Address - Phone:785-532-7755
Practice Address - Fax:785-532-6627
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST04095225100000X
HIPT-42912251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist